CONDITIONS

Hemorrhoids (Piles)

Hemorrhoids (Piles) - Causes, Symptoms, and Treatments

What are hemorrhoids?

Hemorrhoids, also known as piles, are swollen and enlarged veins that develop both internally and externally in the anus and rectum. This condition is a result of increased pressure on these veins. Hemorrhoids can lead to discomfort, pain, and rectal bleeding.

This condition is prevalent in males and females, affecting approximately 50% of the population by age 50.

During pregnancy and childbirth, many women experience hemorrhoids. The pressure exerted on the blood vessels in the pelvic area due to carrying a baby in the womb adds additional strain. Furthermore, the act of pushing the baby out during delivery also elevates pressure on these blood vessels.

What causes hemorrhoids?

Hemorrhoids may occur if:

  • Frequent straining during bowel movements
  • Pregnancy, when the growing uterus presses on veins
  • Family history of hemorrhoids
  • Long-term or chronic constipation or diarrhoea
  • A diet low in fiber

Who is at risk of hemorrhoids?

Hemorrhoid is a common condition that affects a large number of individuals. It is common for people to experience hemorrhoids at some point in their lives.

Factors that increase the likelihood of developing hemorrhoids include:

  • Pregnancy
  • Prolonged hours of sitting as in a sedentary job
  • Obesity
  • Engaging in activities that cause excessive strain, such as heavy lifting
  • Having a family history of hemorrhoids
  • Suffering from long-term or chronic constipation or diarrhoea
  • Being between the ages of 45 and 65.

What are the types of hemorrhoids?

Hemorrhoids can occur inside or outside of the rectum. The type depends on the location where the swollen vein develops. The different types include:

  • External: Swollen veins form underneath the skin around the anus. The anus is the canal through which feces is expelled. External hemorrhoids can be itchy and painful. Occasionally, they may bleed. At times, they may fill with blood that can clot. This condition is not dangerous but can lead to pain and swelling.
  • Internal: Internal hemorrhoids develop when the veins within the rectum become enlarged. The rectum serves as a connection between the colon and the anus in the digestive system. While they may result in bleeding, internal hemorrhoids generally do not cause discomfort.
  • Prolapsed: Both internal and external hemorrhoids can prolapse, which means they stretch and bulge outside of the anus. These hemorrhoids may bleed or cause pain.

What are the common symptoms of hemorrhoids?

Symptoms may differ from person to person. Some of the most common symptoms are:

  • Bright red blood in the stool or the toilet bowl
  • Pain and irritation around the anus
  • Swelling or a hard lump near the anus
  • Itching
  • Pain while sitting in the anal region

How are hemorrhoids diagnosed?

Hemorrhoids can usually be diagnosed by medical history and performing a physical exam.

External hemorrhoids are generally apparent, especially if a blood clot has formed. The doctor may perform a digital rectal exam to check for swollen veins.

They may also examine the lining of the anal canal and rectum with an anoscope, a short plastic tube inserted into the rectum with illumination.

If there is evidence of rectal bleeding or microscopic blood in the stool, flexible sigmoidoscopy or colonoscopy may be performed to rule out other causes of bleeding, such as colorectal polyps or cancer, especially in individuals over age 45.

What is the treatment for hemorrhoids?

Hemorrhoids are treated based on the symptoms, age, and severity. The main goal of the treatment is to reduce the symptoms, which may be done by:

  • Sitting in plain, warm water in a bathtub several times a day (sitz bath)
  • Utilizing ice packs to decrease swelling
  • Using hemorrhoid creams containing a local anesthetic can temporarily soothe the pain, or medications inserted into the rectum (suppositories) help to ease the pain.
  • Softening stool by taking laxatives. Doctors may advise to add more fiber (fruits, vegetables, whole grains) and liquids to the diet.
  • Choosing a cushion over a firm surface can help reduce inflammation in existing hemorrhoids and prevent the formation of new ones.

In case of large hemorrhoids or if creams and laxatives have not been effective, it may be necessary to undergo surgery or other procedures to remove or shrink the hemorrhoids.

  • Rubber band ligation: This involves placing a small rubber band around the base of the hemorrhoid, which cuts off the blood supply to the affected vein.
  • Electrocoagulation: This procedure utilizes an electric current to stop the blood flow to the hemorrhoid.
  • Infrared coagulation: By inserting a small probe into the rectum, heat is transmitted to eliminate the hemorrhoid effectively.
  • Sclerotherapy: This treatment involves injecting a chemical into the swollen vein, which destroys the hemorrhoid tissue.

Surgical treatments include:

  • Hemorrhoidectomy: This surgical procedure is performed to remove large external hemorrhoids or prolapsed internal ones.
  • Hemorrhoid stapling: An internal hemorrhoid can be removed using a stapling instrument or it pulls a prolapsed internal hemorrhoid back inside the anus and hold it in place.

How can one prevent hemorrhoids?

Individuals can take the following steps to reduce the risk of hemorrhoids:

  • Eating more fiber and drinking plenty of fluids can help soften stools and promote regular elimination, reducing straining.
  • Going when feeling the urge to have a bowel movement is important to avoid straining later.
  • Avoiding reading on the toilet is recommended, as sitting, and straining for too long can cause swelling.
  • Regular exercise aids digestion and improves circulation.

In summary, hemorrhoids, also known as piles, are swollen veins in the rectum or anus. They can be internal or external and often result from increased pressure in these areas due to straining during bowel movements or prolonged sitting. Symptoms include pain, itching, swelling, and bleeding during bowel movements. Hemorrhoids are usually not a sign of anything more serious and can often be treated at home. Treatment usually involves lifestyle changes such as increased fiber intake and topical medications. If symptoms persist, surgical procedures like rubber band ligation or hemorrhoidectomy may be necessary.

References

  1. Cleveland Clinic. Hemorrhoids. Available from: https://my.clevelandclinic.org/health/diseases/15120-hemorrhoids. Accessed on May 15th, 2024
  2. Hemorrhoids: Symptoms, Causes, and Treatment. Available from: https://www.webmd.com/digestive-disorders/understanding-hemorrhoids-basics. Accessed on May 15th, 2024
  3. Harvard Health Publishing. Hemorrhoids and what to do about them. Available from: https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them. Accessed on May 15th, 2024
  4. Johns Hopkins Medicine. Hemorrhoids. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hemorrhoids. Accessed on May 15th, 2024

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